Do We Still Need COVID Vaccine Mandates?

Some colleges and universities think that we do. Why?

In January 2020, SARS-CoV-2 virus entered the United States. Everyone in the country was susceptible. We were a blank slate. We didn’t have vaccines, antivirals, or monoclonal antibodies. All we could do was avoid encountering other people. We shuttered schools, closed businesses, restricted travel, wore masks, isolated, quarantined, and tested. By the end of 2020, thousands of people were dying every day.

About one year after the virus entered the country, in December 2020, two COVID vaccines were authorized by the FDA and recommended by the CDC. Both were highly effective and safe. By the middle of 2021, almost all the hospitalizations and deaths from COVID were in those who had chosen not to vaccinate themselves or their families. Sadly, even though vaccines were our ticket out of this pandemic, about 40 percent of Americans still refused to be vaccinated.

Society pushed back.

The prevailing sentiment among Americans at that time was that it wasn’t our inalienable right to catch and transmit a potentially fatal infection. COVID vaccine mandates were born. Hospitals, universities, bars, restaurants, sports venues, airlines, and many businesses began to require vaccination.

Fast forward three years.

By early 2023, we were no longer a blank slate; 96 percent of Americans had either been naturally infected or vaccinated or both. Because of this high level of population immunity, hospitalizations and deaths from COVID declined dramatically. Mandates virtually disappeared. But not all of them. For example, for the 2023 winter semester, Harvard, Fordham, and the University of California schools among others still required a booster dose of a bivalent COVID vaccine to enter campus.

If you define a pandemic as something that changes the way we live, work, or play, then the COVID pandemic is over. We must now ask ourselves: “Do vaccine mandates still make sense?” Or, said another way, “What is the goal of COVID vaccines in a post-pandemic world?”

The goal of COVID vaccines now, as it was at the start of the pandemic, is to prevent serious illness—to keep people out of the hospital, out of the intensive care unit, and out of the morgue. Those most likely to suffer severe disease, who would then most likely benefit from a booster dose of a bivalent vaccine, fall into four categories: (1) people over 75; (2) people with multiple health problems; (3) people who are immune compromised; and (4) women who are pregnant. Healthy young people, like those who attend colleges and universities, are unlikely to be in any of these high-risk groups.

So, why do some universities still require their students to be boosted?

If university administrators believe that a bivalent booster dose will provide better protection against severe disease, they should be reassured that three doses of a COVID vaccine or two doses plus a natural COVID infection likely provides long-lived protection against severe disease. At this point, those who are young and healthy don’t appear to need another booster dose.

If administrators are trying to prevent all symptomatic illness for students living in dormitories, they should realize that protection against mild illness afforded by a booster dose will likely last only a few months. Trying to protect against all symptomatic illness would require frequent booster dosing, which is not a viable public health strategy.

All vaccines have risks. While it is reasonable for colleges or universities to offer booster dosing to those who want it, it is unreasonable to mandate booster dosing for students who are already protected against serious illness unless the benefits clearly outweigh the risks. And in this case, the benefits are, at best, marginal.